In a significant policy change, Bush administration officials say that Medicare will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, a move they say could save lives and millions of dollars.

Private insurers are considering similar changes, which they said could multiply the savings and benefits for patients.

Under the new rules, to be published next week, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.”

Among the conditions that will be affected are bedsores, or pressure ulcers; injuries caused by falls; and infections resulting from the prolonged use of catheters in blood vessels or the bladder.

In addition, Medicare says it will not pay for the treatment of “serious preventable events” like leaving a sponge or other object in a patient during surgery and providing a patient with incompatible blood or blood products.

SAVANNAH, Ga. – Southside Fire and EMS has added a special-order ambulance meant for very obese patients to its fleet of emergency vehicles.

It’s getting great business.

Southside is using the bariatric ambulance for anyone larger than 400 pounds. It has been used more than once a day since it was delivered in late June. The largest patient transported thus far weighed 730 pounds.

It’s also being used to transport normal-weight patients, but special features, including a cot that can hold a 1,600-pound patient, are easing transport problems with larger patients.

Learning how to practice medicine on this sort of a time-scale is stressful. But it’s totally necessary in order to properly train us for a world of health care in which the average physician visit is six minutes! When our professors went to medical school, they were taught the art of healing; we are taught how to diagnose and treat patients in a limited timeframe. I can’t help but think, is this what I signed up for?

A lawsuit alleging that a Florida car crash victim might have survived if a helicopter had been sent instead of an ambulance may be the first legal challenge of its kind in the nation.

Sharon Hanlon, the attorney representing family members of the deceased woman, Diana Lopez, said Collier County emergency personnel were lax when they allegedly declined to provide air transport because of her weight, which reportedly exceeded 300 pounds. That negligence occurred due to failure to clarify the rules/procedures regarding heavy-set patients who are trauma alert patients, she said.

Ms. Lopez was in her mid-30s, was a business owner of a trucking company, recently underwent gastric bypass surgery, and had lost 94 pounds. She was in good health and looking forward to life, Ms. Hanlon asserted.

The defense countered that the sole proximate cause of the plaintiff’s damages was the decedent’s own negligence and actions, or omissions, including, but not limited to, failing to wear a seatbelt. County officials appear confident that neither Collier County nor its Emergency Medical Services will be held liable. We believe that the county has many viable defenses to this action, said Assistant County Attorney William Mountford, who filed Collier County’s legal reply to the wrongful death suit.

Being named in a malpractice suit is bad enough. Being told by your attorney and insurance carrier that the case “just isn’t defensible” is worse still.

Those discouraging words—which, when combined, usually spell “settlement”—aren’t always based on medical events. Two physicians might provide the same treatment to similarly afflicted patients, resulting in the same unfortunate outcome, but one doctor goes to court and wins, while the other is forced to settle for $1 million.

Why the difference? Partly, it’s the vagaries of the legal system, which relies on judges, attorneys, and juries that differ from jurisdiction to jurisdiction and case to case. Partly it’s because your insurer might prefer to avoid the expense of litigation. (See “Sued? You may never get your day in court,” Aug. 4, 2006.) But mostly it’s because the nonmedical aspects of a malpractice case can trump the therapeutic ones. Defense attorneys, after weighing all the pertinent factors, might conclude that you’re best off settling out of court because you’re not likely to fare well before a judge and jury.